card credit gas rebate

							                                                         INFORMATION BROCHURE
                                   Queensland Government
                                Reticulated Natural Gas Rebate
The information brochure is provided as a guide only to aid the applicant in completing the attached Application for
the Reticulated Natural Gas Rebate. No liability, express or implied, is accepted for the contents of the information
brochure.

If you are a consumer of reticulated natural gas purchased from a Retail Entity and are in receipt of one of
the cards stated below, you may be eligible for a rebate of $0.1579 inclusive of GST per day on your
reticulated natural gas account. Your account will show the amount of rebate deducted.

If you are a consumer of reticulated natural gas not purchased from a Retail Entity and reside in a
residential home park or in multi-unit residential premises, you may also be eligible for a rebate, provided
the proprietor of the premises participates in the rebate arrangements. Details of arrangements for such
situations are available on request from the proprietor of the premises.

On completion of the Application Form please return it to your Retail Entity.

Subject to the conditions listed below, persons who hold one of the following cards may apply for the
reticulated natural gas rebate.

        Pensioner Concession Card
         You MUST hold a current and valid Pensioner Concession Card, issued by either Centrelink or
         the Department of Veterans’ Affairs, to be eligible for the reticulated natural gas rebate.

        Repatriation Health Card – For All Conditions (Gold Card)
         You MUST hold a current and valid Repatriation Health Card – For All Conditions (Gold Card)
         and be in receipt of one of the following payments to be eligible for the reticulated natural gas
         rebate.
              War Widow
               (including Widowed Mother [AMS] Pension)
              Special Rate T.P.I.
               (Including Blinded Disability) Pension
        Queensland Government Seniors Card
         You MUST hold a current and valid Queensland Government Seniors Card issued by Department
         of Communities to be eligible for the reticulated natural gas rebate.

Eligibility Criteria
Eligible Pensioners and Seniors who claim the rebate shall have the rebate granted, provided that Condition
(a) and the relevant sections of Condition (b) are met:

       (a) The customer must be a registered reticulated natural gas consumer of the Retail Entity at the
           premises for which the rebate is claimed and the premises must be the customer’s principal
           place of residence, and the only residence in Queensland for which the customer claims the
           rebate; and
       (b) The customer must live alone or share the premises in respect of which the rebate is claimed
           with:
           (one or more of the following sub-conditions may apply)
           (I)     the customer’s spouse; or                                                 CONTINUED OVER PAGE


                                                                                                                   
          (II)    other persons who hold a Queensland Government Seniors Card or Pensioner
                  Concession Card: or
          (III)   other persons wholly dependent on the customer; or
          (IV)    other persons who receive an income support payment from Centrelink, Family
                  Assistance Office or Department of Veterans’ Affairs who do not pay rent; or
          (V)     other persons who live with the customer to provide care and assistance, and who do
                  not pay rent; and

        declare that no other person(s) except casual visitors share the residence with the
        customer.
How to Apply for the Reticulated Natural Gas Rebate
All eligible customers who satisfy the conditions under which the rebate will be granted, as listed above,
and who wish to claim the rebate/s can at the discretion of the Retail Entity, either complete a written
Application for Reticulated Natural Gas Rebate or apply by telephoning their Retail Entity.
Failure to satisfactorily complete the written application form may delay the operative date of the rebate.
If you are uncertain how to complete the application form please seek advice from your Retail Entity.
Where a reticulated natural gas account is in more than one name, only one person who is eligible to
receive the rebate and resides at the residence can receive the rebate.

Lodging Your Application
The Retail Entity accepts no liability for the loss of an application. The Retail Entity will make every
endeavour to credit the reticulated natural gas rebate on the customer’s relevant account. It is the
customer’s responsibility to check all reticulated natural gas accounts to ensure that the rebate has been
credited.

Privacy notice
The Retail Entity is collecting the information on the application form to assess your eligibility for the
concession and to manage payments of the concession if it is granted. If you do not provide this
information, your application will not be able to be processed. The Retail Entity usually gives some or all
of this information to:
 Centrelink
 Department of Veterans’ Affairs
 Department of Communities (Concession Services and Card Services, Smart Service Queensland).
Verification of eligibility
The concession will only be paid if the customer gives their consent to the Retail Entity to disclose
relevant personal information to the Department of Communities, Centrelink, and Department of
Veterans’ Affairs, so they can check the customer’s continued eligibility for the concession.
Change in Circumstances
Customers must notify their Retail Entity immediately of any changes to their address or eligibility to
receive the concession. The Retail Entity may require a new application to be submitted.
Renewal of Application
Renewal of application for the rebate may be required periodically at the discretion of the Retail Entity.

Fraudulent Claims
The Reticulated Natural Gas Rebate scheme was introduced to provide concessions to those people
considered most in need of financial assistance. Where such an application has been submitted for the
purpose of fraudulently obtaining a rebate, legal action may be taken against the customer.

Further Information
If you require further information or assistance with completion of the application form please telephone
your Retail Entity.
                                                                                                                       APPLICATION FORM
                                                 Reticulated Natural Gas Rebate
 This Application Form applies only where the applicant is a consumer of reticulated natural gas purchased from a Retail
                                                          Entity.
This form must be completed by the customer and lodged with the Retail Entity for the rebate to apply. Please refer to the attached Information
Brochure before completing this application. Further assistance is available from your Retail Entity staff.




…………………………………………………………………………………..                                                                      ……………………………………………………………………….
Given Name            (Please Print)                                                                  Surname

……………………………………………………………………………………………………………………                                                                                                 ………………………………………..
Full Residential Address (Please Print)                                                                                                    Telephone Number




 My reticulated natural gas account number is:                                                                      ……………………………………………………………..


              I hold one of the following current and valid cards:                                                   PLEASE PROVIDE CARD/FILE NUMBER
  PENSIONER CONCESSION CARD                                                                                                               Veteran’s Affairs Number
    Card Issued By: (Please tick  appropriate box)


             Veterans’ Affairs; or                                                                                                           Centrelink Number

                                                                                                                                                -                   -
             Centrelink                                                                                            CRN
  REPATRIATION HEALTH CARD – FOR ALL CONDITIONS (Gold Card)
                                                                                                                                                 File Number
   AND receiving either of the following benefits:
        SPECIAL RATE T.P.I. 

             WAR WIDOWS 

  QUEENSLAND GOVERNMENT SENIORS CARD
                                                                                                                    Card Number



      Who I live with: (Please read the following statement carefully and tick  the box to confirm that it applies to you)


              I live alone or with other persons as described below:
                    With my spouse/defacto and /or other persons who are wholly dependent on me
                    With other people who hold a Pensioner Concession or Queensland Government Seniors Card
                    With other people who receive a Centrelink, Family Assistance Office or Dept of Veterans’ Affairs payment, and who DO
                     NOT pay rent
                    With other people who provide care and assistance, and who DO NOT pay rent
              AND

              I DO NOT share my residence with any other persons except casual visitors.



                                                                                      Declaration
 1.     I advise that the above address is my principal place of residence and is the only residence within Queensland for which the rebate is
       claimed by me and the above reticulated natural gas account is solely or jointly in my name.
 2.    I will notify the Retail Entity immediately of any change in my circumstances, which may affect my eligibility for the rebate.
 3.    I authorise Centrelink to confirm with <retail entity> the current status of my Commonwealth Benefit and other details as they pertain to my
       concessional entitlement. This involves electronically matching details I have provided to the <Retail Entity> with Centrelink or Department of
       Veterans’ Affairs (DVA) records to confirm whether or not I am currently receiving a Centrelink or DVA benefit.
       I understand that this consent, once signed, is effective only for the period I am a customer of <Retail Entity>. I also understand that this
       consent, which is ongoing, can be revoked any time by giving notice to <Retail Entity>.
       I understand that if I withdraw my consent, I may not be eligible for the concession provided by <Retail Entity>.
 4.    I consent to the Retail Entity providing my details to the Department of Communities, (Concession Services and Card Services) for the
       purpose of determining or confirming my continued eligibility.
 5.    I declare that all the information that I have given is true and correct.

        Signature of Applicant: ........................................................................................................         Date: ......../........./..........